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Device for internal ligation of tubular structures

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Publication number
CN100462057C
CN100462057C CN 03804202 CN03804202A CN100462057C CN 100462057 C CN100462057 C CN 100462057C CN 03804202 CN03804202 CN 03804202 CN 03804202 A CN03804202 A CN 03804202A CN 100462057 C CN100462057 C CN 100462057C
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CN
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Prior art keywords
device
internal
ligation
tubular
structures
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CN 03804202
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Chinese (zh)
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CN1635854A (en )
Inventor
A·M·L·麦克莱伦
P·M·穆利
S·B·麦克莱伦
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生物医学工程解决方案公司
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022Occluding by internal devices, e.g. balloons or releasable wires
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12136Balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F6/00Contraceptive devices; Pessaries; Applicators therefor
    • A61F6/20Vas deferens occluders; Fallopian occluders
    • A61F6/202Means specially adapted for ligaturing, compressing or clamping of oviduct or vas deferens
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F6/00Contraceptive devices; Pessaries; Applicators therefor
    • A61F6/20Vas deferens occluders; Fallopian occluders
    • A61F6/208Implements for ligaturing
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F6/00Contraceptive devices; Pessaries; Applicators therefor
    • A61F6/20Vas deferens occluders; Fallopian occluders
    • A61F6/22Vas deferens occluders; Fallopian occluders implantable in tubes
    • A61F6/225Vas deferens occluders; Fallopian occluders implantable in tubes transcervical
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B17/22032Gripping instruments, e.g. forceps, for removing or smashing calculi having inflatable gripping elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082Probes or electrodes therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B2017/12018Elastic band ligators
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2215Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • A61B2017/303Surgical pincettes without pivotal connections with four or more legs

Abstract

一种用于实施输卵管(31)或其它管状解剖结构的内部结扎的外科装置,其通过将一个或多个结扎带(41)施加至折叠的输卵管结构的壁部分来完成。 A method for tubal (31) or other surgical device ligation inside the tubular anatomical structure, which is applied to the folded portion of the fallopian tube wall structure by one or more ligating band (41) to complete. 还公开了一种使用该装置的方法。 Also disclosed is a method of using the device. 本发明的方法和装置可用于绝育,以防止不必要的受孕,或用于其它医学应用。 The method and apparatus of the present invention may be used for sterilization, to prevent unwanted pregnancy, or for other medical applications. 该装置的一个实施方案包括插入到输卵管的伸长的管状元件(21);从该管状元件(21)伸出的抓紧器(51),其抓住输卵管(31)的内部并缩回到管状元件内,得到输卵管组织的折叠束;和一个推进器气囊(42),其用于将结扎带(41)从管状元件的端部推进组织束中。 One embodiment of this apparatus comprises an elongated tubular element is inserted into the fallopian tube (21); from the tubular member (21) protruding grasper (51), which catch inside the oviduct (31) and is retracted into the tubular the inner member, to obtain the folded beam fallopian tubes; balloon and a pusher (42) for ligating band (41) from an end portion of the tubular member to promote tissue bundles. 还可以包括折叠辅助装置以帮助翻转输卵管或其它管子的一部分。 It may further include an auxiliary means to assist folding flip part of the fallopian tubes or other tube.

Description

用于管状结构的内部结扎的装置 Means for ligating internal tubular structure

技术领域 FIELD

本发明涉及用于阻断管状解剖结构的方法。 The present invention relates to a method for blocking the tubular anatomical structure. 具体地,本发明涉及结扎输卵管以实现绝育的方法。 In particular, the present invention relates to a method for tubal ligation to achieve sterilization. 本发明也涉及执行输卵管结扎的装置。 The present invention also relates to apparatus performing tubal ligation.

背景技术 Background technique

对于多种医学处理,管状解剖结构的阻塞是必要的。 For a variety of medical treatment, obstruction of tubular anatomical structure is necessary. 阻塞技术的一个重要应用是阻断女性的输卵管或男性的输精管以实现绝育和防止不必要的受孕。 An important application is blocking technology to block women's fallopian tubes or vas deferens in men to achieve sterilization and prevent unwanted pregnancy.

为了避孕的目的,已经考虑了用于实现管状解剖结构的阻塞或阻断的多种方法。 For purposes of contraception it has been considered various methods for implementing the tubular anatomical structure of blocking or blocking. 一种通常被应用的用于阻断输卵管的方法是将输卵管打结或夹紧。 A method for blocking the fallopian tube is usually applied to the tie or clamping fallopian tubes. 可在输卵管的两个位置打结,然后移去中间的部分。 May be knotted at two positions of the fallopian tubes, the middle portion is then removed. 通过夹紧并折叠输卵管的一部分,并将与输卵管的余下部分不连通的成环部分打结,也可以获得相似的结果。 By clamping and folding a portion of the fallopian tube and knotted to form a ring with the remainder portion of the fallopian tube does not communicate, similar results can be obtained. 输卵管折叠的部分可通过一圈 Fallopian tube by lap folded portions

缝合材料、弹性结扎带或o形圈、或夹子被阻断。 Suture materials, elastomeric o-rings or ligating band, or a clip is blocked. 与输卵管的接触通 Through contact with the oviduct

常是通过内窥镜手术实现的,要么通过腹壁,或者,较少见地,通过阴道壁。 Often achieved by endoscopic surgery, or through the abdominal wall, or, more rarely, through the vaginal wall. 这样的方法比传统的手术方法侵入性较小,但仍有不必要的高感染和组织损坏的危险,且伴随有不必要的康复时间和一定程度的不适。 This method is less invasive than traditional surgical methods, but there are still unnecessarily high risk of infection and tissue damage, and accompanied by unnecessary recovery time and a certain degree of discomfort.

为了消除对内窥镜或其它更具侵入性的手术的依赖,已设计出多种方法,用于在进入输卵管内部后阻断输卵管的内腔,这是通过经阴道和子宫插入导管到输卵管的内腔来完成的。 In order to eliminate the dependence on an endoscope or other more invasive procedures have been designed a variety of methods for blocking the lumen of the fallopian tubes into the interior of the fallopian tube, this is accomplished by inserting a catheter through the vagina and the uterus to the oviduct lumen to complete.

一种方法是通过注入粘合剂或密封剂,通常是聚合物材料到输卵管中以形成塞子,从而阻断输卵管。 One method is by injecting an adhesive or sealant, generally a polymeric material into the fallopian tube to form a plug to block the fallopian tube. 另一种方法是插入一种预先成形的阻塞性装置或塞子到输卵管内腔或子宫输卵管联结处中。 Another method is to obstructive means or plug or lumen of the fallopian tube is inserted at the utero-tubal junction one kind preformed. 然而,每种类型的塞子都可能与输卵管壁分开或脱离,导致不可靠或非永久性阻断。 However, each type of plug may separate or detached from the wall of the fallopian tube, leading to unreliable or non-permanent blocking.

另一种用于阻断输卵管或其它管状解剖结构的方法是诱导硬结或创伤组织的形成以阻断输卵管。 Another method for blocking the fallopian tube or other tubular anatomical structure is to induce the formation of sclerosis or wound tissue to block the fallopian tube. 可通过化学或热诱导组织损伤。 Tissue damage may be induced chemically or thermally. 然而, 用该方法的成功实现相对困难,且要求熟练的医务人员及特殊的设备, 使得其在某些情况下不合适。 However, the success achieved with this method is relatively difficult and requires skilled personnel and special equipment, such that it is inappropriate in some cases.

希望对现有技术的改进能提供一种方法和系统,其用于施加结扎结构物至管状解剖结构的内部。 Desirable improvement over the prior art to provide a method and system for applying a ligature to the inner tubular structure of the anatomical structure. 所希望的改进将得到管状解剖结构的可靠的阻塞。 The desired improvements reliable blocking of the tubular anatomical structure. 所希望的管状解剖结构这样的阻塞在某些应用中是永久的,如生殖中的避孕。 Such blocking the desired tubular anatomical structure in certain applications is permanent, such as the reproduction of contraception. 用于阻塞管状解剖结构的廉价的方法也是所希望的。 Inexpensive method for blocking the tubular anatomical structure is desired. 一种改进可以提供一种部分或完全一次性使用的装置,其用于执行管状解剖结构的阻塞。 An improved apparatus can be provided partially or entirely disposable, for performing the blocking of the tubular anatomical structure. 进一步的提高是提供一种用于执行输卵管结扎的改进的方法,该方法只要求具有最小侵入性的手术,因此减少了对血管和生殖组织的损伤,且减少手术后的不适和康复时间。 Further improvement is to provide an improved method for performing tubal ligation, which requires only minimally invasive surgery has, thus reducing damage to the vessel and reproductive tissues, and reduces the discomfort and the recovery time after surgery. 一种能够进一步减少感染危险的用于输卵管结扎的方法也是所需要的。 Which can further reduce the risk of infection method for tubal ligation is required.

发明概述 SUMMARY OF THE INVENTION

按照此处宽泛描述和具体说明的本发明,提供一种装置,其用于施加结扎带到管状解剖结构内部的组织。 And broadly described herein, according to the present invention is specifically described, there is provided an apparatus for applying a ligature to the interior of the tubular anatomical structure of the tissue. 本发明也包括使用该装置的方法。 The present invention also includes a method of using the device.

本装置可体现为外科器械,通过阻塞输卵管,其用于女性生殖的 This apparatus may be embodied as a surgical instrument, by blocking the fallopian tubes, for female reproduction

避孕。 contraception. 这样的装置具有近端和远端(a proximal and a distal end),该装 Such means having a proximal end and a distal end (a proximal and a distal end), the apparatus

置通常是伸长的且经配置以允许远端经阴道和子宫插入到输卵管,而在近端,该装置于病人的体外被掌握和控制。 Opposing elongated and is generally configured to allow the distal end is inserted into the oviduct through the vagina and uterus, and at the proximal end, the device is in the possession or control of the patient in vitro.

该女性避孕装置通常包括伸长的管子,其具有中央的、纵向延伸的内腔和安置于伸长的元件的一端的抓紧器(grasper),该伸长的元件可滑移地安置在该内腔中。 The female contraceptive device comprising a generally elongated tube having a central, longitudinally extending lumen and disposed at one end of the elongate element grasper (grasper), the elongated member slidably disposed in the inner cavity. 该抓紧器能够从管子的远端向远处伸出, 抓住输卵管内部的组织,且和被抓住的组织向近处收回。 The grasper can extend distally from the distal end of the tube, grasp the tissue inside the fallopian tube, and the caught tissue and retracted proximally. 可以在管子的远端提供包括活动装置的结构,以帮助产生巻绕的折叠,或产生输卵管的内陷,形成组织束(tissue bundle)或组织蒂(peduncle)。 Activity may comprise providing a structure at the distal end of the tube means to assist folding around Volume produce, or produce retraction of the fallopian tube, the beam forming a tissue (tissue bundle) or tissue pedicle (peduncle). 一个或多个结扎带通常附在管子的远端附近。 Distal ligating band is typically attached to one or more of the tubes in the vicinity. 结扎带可从管子的远端释放, 在组织束周围像括约肌一样地收縮,从而阻塞穿过输卵管的通道。 Ligating band can be released from the distal end of the tube, as like a sphincter contracted tissues around the beam so as to block passage through the oviduct. 一种释放结扎带的方式是绕着管子可滑移地安置的袖套(sleeve)的远端将结扎带从带子支撑结构处移走,而将结扎带向远处移动。 Way ligating band is released distal end slidably disposed about the tube of the cuff (Sleeve) will be removed from the ligating band supporting structure at the tape, while the ligating band to the distance moved.

该装置的近端装配有手柄或基座和多个位于其上的控制器,以控制抓紧器相对管子的伸出和收回、抓紧器的促动和结扎带对组织束的释放,以及其它的操作。 Assembling the proximal end of the device with a handle or a base and a plurality of controllers on which to control the grasper relative extension and retraction of the tube, the grasper and the actuation of the release of tissue ligating band beam, and other operating. 该装置可装配有电流源,其用于提供电流, 以烧灼被抓紧器抓住的组织,或使该抓紧器与延伸的元件分离开。 The device may be equipped with a current source for supplying current to cauterize tissue caught grasper, the grasper or to extend the separating element. 在结扎处的附近,该装置也提供有额外的内腔,用于输送药物或其它化合物,如抗生素、局部麻醉剂或化学烧灼试剂。 In the vicinity of the ligation, the device is also provided with an additional lumen for delivery of drugs or other compounds, such as antibiotics, local anesthetics or chemical cauterizing agents.

一种使用该装置的方法包括下列步骤:插入该装置的远端至管状解剖结构中,使抓紧器从管子向远端伸出,用该抓紧器抓住管状解剖结构内部的组织,向近处收回抓紧器,形成内部组织束,从管子远端释放结扎带,在组织束周围像括约肌一样地收縮。 A method of using the apparatus comprising the steps of: inserting the distal end of the device to the tubular anatomical structure, the grasper extends distally from the tube, grasp tissue inside the tubular anatomical structure with graspers, proximally retracted graspers, tissue is formed inside the beam, is released from the tube distal ligating band, at the same shrinkage as the sphincter surrounding tissue bundles. 该方法可进一步包括撤开该装置至管状解剖结构的新位置的步骤,和重复前面的步骤以施加一个或更多额外的结扎带。 The method may further comprise the step of withdrawal opening of the apparatus to a new position of the tubular anatomical structure, and repeat the previous steps to apply one or more additional ligating band.

附图说明 BRIEF DESCRIPTION

这些附图是为了说明用于实施本发明的优选实施方式。 These drawings are used to illustrate the preferred embodiments of the present invention embodiment.

图1是插入到病人输卵管中的装置的一个实施方式的视图,其具 FIG 1 is a view showing an embodiment of inserting the device in the patient's fallopian tube, which has

有以示意的形式示出的用于该装置的控制器; There is shown in schematic form a controller for the apparatus;

图2是定位在输卵管中的该装置的一个实施方式的透视图,其具 FIG 2 is a perspective view of the fallopian tubes positioned in an embodiment of the apparatus, with which

有未延伸的抓紧器轴; There grasper shaft unextended;

图3是沿图2中线3-3的纵向横剖面视图; FIG 3 is a longitudinal cross-sectional view taken along line 3-3 of FIG 2;

图4显示用于释放结扎带的一种可供选择的推进器装置; Figure 4 shows a device for releasing the pusher alternative ligating band;

图5是沿图3中线5-5的横截面视图; FIG 5 is a cross-sectional view taken along line 5-5 of FIG 3;

图6是图2到图5中的装置的透视图,其显示放了气的气囊和延伸的导管; FIG 6 is a perspective view of the apparatus of FIG. 2 to FIG. 5, which shows the discharge gas and the balloon catheter extends;

图6.5是该装置的一个可供选择的实施方案的纵向剖面视图; Figure 6.5 is a longitudinal sectional view of an alternative embodiment of the device;

图6.6是利用吸管作为抓紧器的装置的一个实施方案的透视图; Figure 6.6 is a perspective view of the use of straw as an embodiment of the grasper device;

图7说明了该装置端部的一个可供选择的实施方案,其具有附在 7 illustrates an alternative embodiment of the device end portion having attached

该装置上的两个O形圈和一个可供选择的抓紧器; Two O-rings on the device and an alternative grasper;

图8说明了该装置端部的又一个可供选择的实施方案,其具有附 Figure 8 illustrates a further alternative embodiment of the end of the device, which has an attachment

在该装置上的两个O形圈和另一个可供选择的抓紧器; On the device and two O-rings another alternative grasper;

图9是沿图6中的线9-9的纵向剖面视图; FIG 9 is a longitudinal cross-sectional view taken along line 9-9 of FIG 6;

图10是示于图2-9中的装置的纵向剖面视图,其示出了气囊膨胀, FIG 10 is a longitudinal cross-sectional view of the apparatus shown in FIG. 2-9, which shows the balloon is inflated,

以强迫倒钩进入输卵管壁; To force the barb into the fallopian tube wall;

图11是该装置的纵向剖面视图,其示出了气囊縮小,以径向地向 FIG 11 is a longitudinal cross-sectional view of the device, showing a balloon reduced to the radially

内牵引输卵管壁; The traction oviduct;

图12是该装置的纵向剖面视图,其示出了抓紧器撤回到外部管子 FIG 12 is a longitudinal cross-sectional view of the device, which is shown outside of the tube to withdraw the grasper

中,牵引输卵管的折叠部分随之进入外部管子中; , The folded portion of the fallopian tube subsequent pulling into the outer tube;

图13是该装置的纵向剖面视图,其示出了推进器气囊膨胀,从而将结扎带从外部管子的末端推出,而使其落到输卵管折叠部分上; FIG 13 is a longitudinal cross-sectional view of the apparatus, showing a pusher balloon is inflated, thereby ligating band out of the end of the outer tube, and the folded portion of the fallopian tube so as to fall on;

图14是结扎的输卵管的纵向剖面视图; FIG 14 is a longitudinal cross-sectional view of the tubal ligation;

图15是施加第二个结扎带后的输卵管的纵向剖面视图; FIG 15 is a longitudinal cross-sectional view of the tubal second ligating band is applied;

图16是本发明的一个可供选择的实施方案的平面图; FIG 16 is a plan view of an embodiment of the present invention is an alternative;

图17是安置在输卵管中用于输卵管结扎的装置的端部的纵向视图,其部分地以剖面示出; FIG 17 is disposed in the oviduct a longitudinal view of the end portion of the tubal ligation apparatus, partially shown in cross section;

图18是类似于图17的视图,但具有在输卵管结扎的初始阶段中可膨胀的气囊; FIG 18 is a view similar to FIG. 17, but at an initial stage tubal ligation with the inflatable bladder;

图19是类似于图18的视图,但具有在输卵管结扎的中间阶段中部分地向近端收縮的气囊; FIG 19 is a view similar to FIG. 18, but at an intermediate stage having a tubal ligation of partially contracted balloon proximally;

图20是类似于图19的横截面视图,但是它是在输卵管结扎几乎完成时的构型。 FIG 20 is a cross-sectional view similar to FIG. 19, but it is the configuration when the almost finished tubal ligation.

优选实施方式 Preferred embodiments

图1示出了本发明用于实施管状结构的内部结扎的装置的一个实施方式,该装置标注为20。 FIG 1 illustrates one embodiment of the present invention for carrying out the ligation of the internal configuration of the tubular device, the device denoted 20. 装置20包括伸长的管状元件21,其具有近端22和远末端23。 Device 20 comprises a tubular elongated member 21 having a proximal end 22 and distal end 23. 管状元件21的近端22连接到控制部分24,该控制部分包括用于控制该装置的控制器25、 26、 27和28,它们也用于在使用过程中支撑该装置。 The proximal end 21 of the tubular member 22 is connected to the control section 24, the control section comprises a controller for controlling the apparatus 25, 26, 27 and 28, they are also used to support the device during use. 控制部分24可配置为手柄的形式,以便使用该装置的人手持之,或经配置而固定在检查台或其它基座上。 The control section 24 may be configured in the form of a handle for use with the person holding the device, or configured to be fixed to the examination table or other base. 装置20由控制部分24支撑和控制,而远末端23经阴道32、子宫34的内腔33和子宫角35被插入到病人的输卵管31的内腔30。 Means 20 by the control section 24 and a control support, the distal tip 23 and 32 vaginal, uterine lumen 33 and 35 of the uterine horn 34 is inserted into a patient's fallopian tube lumen 3031. 卵巢36也示于图1中。 Ovarian 36 also shown in FIG. 近端22可包括接通口37,以允许麻醉剂、抗生素或其它物质注入到管状元件21,并扩散到结扎处附近的输卵管中。 22 may include a proximal port 37 is turned on to allow the anesthetic agent, antibiotic or other substance into the tubular member 21, and spread to the vicinity of the oviduct ligation.

图2示出了图1中被圈住的区域2的细节,也就是在装置20的管状元件21的远末端23的其它组件。 Figure 2 shows a detail of FIG. 1 in the encircled area 2, i.e. the tubular element 20 in the apparatus 21 of the distal end 23 of the other components. 被示出的管状元件21定位在输卵管31的内腔30中,输卵管的壁39以剖面示出。 The tubular member 21 is shown positioned in the lumen 30 of the fallopian tube 31, the wall 39 of the fallopian tube shown in cross section. 管状元件21的远末端23包括唇缘40,其上有结扎带41。 The distal end 23 of the tubular member 21 includes a lip 40, on which a ligating band 41. 结扎带41可以是用于实施管状结扎的已知类型的带子,可由橡胶、硅树脂和其它合适的材料制成。 Ligating band 41 may be a known type of belt for carrying the tubular ligation, made of rubber, silicone and other suitable materials. 其它结扎结构物,如缝合环或夹子也可以被使用。 Other ligation structures, such as a ring or suture clip may also be used. 在临近结扎带41的近端是推进器42,在本例中,它是具有通常的螺旋管形的推进器气囊。 Towards the proximal end of the ligating band 41 of the pusher 42 is, in the present embodiment, it is the balloon pusher having a generally toroidal. 推进器气囊42可向远处扩张以将结扎带41从管状元件21的远末端23 推出。 The pusher 42 may airbag 41 from the distal end 23 of the tubular element 21 is introduced to the expansion of the distance to the ligating band. 抓紧器38的抓紧器轴44的远端端部43在管状元件21的内腔45中是可见的。 Grasper distal end 44 of the grasper shaft 38 in the interior 43 of the tubular member 21, 45 is visible. 抓紧器轴44示于未延伸的位置,这样,端部43没有显著超出管状元件21的远末端23。 Grasper shaft 44 is shown in unextended position, so that the end portion 43 is not significantly greater than the far end 21 of the tubular member 23. 在装置20插入到病人的输卵管中时,抓紧器轴44优选保持在未延伸的位置。 When the apparatus 20 is inserted into the patient's fallopian tube, the grasper shaft 44 is preferably held in the unextended position.

图3是装置20沿图2中的线3-3的剖面视图。 3 is a sectional view of the apparatus 20 along line 3-3 of FIG. 抓紧器38可滑移地置于管状元件21地内腔45中。 Grasper 38 slidably disposed in the lumen 21 of the tubular member 45. 在示于此处的本发明实施方式中,抓紧器38包括抓紧器轴44,它是中空的,具有中央内腔50,还包括气囊51 ,该气囊附在抓紧器轴44上。 In the embodiment shown in the embodiment of the present invention herein, the grasper 38 includes a grasper shaft 44, which is hollow, having a central lumen 50, further comprising a balloon 51, the balloon 44 is attached to the grasper shaft. 抓紧器轴44的内腔50经流体通道53a和53b与气囊51的内部52相通。 Grasper lumen 50 of shaft 44 in communication via the internal fluid channel 52 and 53a and 53b of balloon 51. 在使用中,气囊51通过注射器或其它加压源注入流体而充至所选的压力或体积。 In use, the balloon 51 is charged to a selected pressure or volume of fluid injected by syringe or other pressure source. 在本说明书中,流体趋向于是液体和气体。 In the present specification, the fluid tends to liquids and gases. 抓紧器轴44中的流体和气囊51的内部52可以是例如空气或盐水。 Inner balloon 52 and the fluid 51 in the grasper shaft 44 can be, for example, air or saline. 气囊51可以以与气囊血管成形术导管相同的方式膨胀。 Balloon 51 may be the same with the angioplasty balloon catheter inflated manner. 多个倒钩附在气囊51的外部,其中只有54a和54b在此剖面中可见。 A plurality of barbs attached to the outer air bag 51, of which only 54a and 54b are visible in this cross section. 管状元件21的通道46a和46b与推进器气囊42的内部47相通。 The tubular member 21 is of channel 46a and 46b with the interior of balloon pusher 4742 communicates. 来自于连接在通道46a和46b的近端的注射器或其它加压源的空气或流体,被强行推入推进器气囊42,以使其膨胀并将结扎带41推出唇缘40。 From the connection passage 46a and 46b at the proximal end of the syringe or other source of pressurized air or fluid, and is forcibly pushed into the airbag pusher 42, so as expanded ligating band 41 and the lip 40 Release.

图4示出本发明的一个可供选择的实施方式,其中,由推进器杆49a和49b驱动的推进器盘48被使用,以取代推进器气囊42。 Figure 4 shows an alternative embodiment of the present invention, wherein, 49a and 49b by a disk drive pusher pusher rod 48 is used, the air bag 42 to replace the pusher. 推进器杆49a和49b是可滑移地置于通道46a和46b中,且被机械促动器(未示出)驱动,该机械促动器位于该装置的近端,在控制部分24处。 The pusher rod 49a and 49b are slidably disposed in channels 46a and 46b, and is (not shown) driving a mechanical actuator, a mechanical actuator located in the proximal end of the device, the control section 24. 本领域的普通技术人员可设计出多种促动装置,以使推进器杆49a和49b 移动推进器盘48,从而将结扎带41 (未示出)从唇缘40的带支持结 Those of ordinary skill in the art can design a variety of actuation means, so that the pusher rod 49a and 49b move the pusher plate 48, so that the ligating band 41 (not shown) from the junction with the lip 40 to support the

构推出。 Configurations available.

图5是沿图3中剖面线5-5的剖面视图。 5 is a sectional view of FIG. 3 along section line 5-5 of FIG. 管状元件21中的通道46a 和46b可以被看见,流体通道53a、 53b、 53c和53d也能被看到,它们提供了在抓紧器轴的内腔50和气囊51的内部52间的流体连通。 21 a tubular element channel 46a and 46b can be seen, the fluid passage 53a, 53b, 53c and 53d can also be seen, which is provided between the internal fluid lumen shaft 52 of grasper 50 and the airbag 51 communicates. 流体通道53c和53d在图3的剖面视图中是不可见的。 A fluid passage 53c, and 53d in a cross-sectional view of FIG. 3 is not visible. 而且,所有多个倒钩54a、 54b、 54c等在此剖面视图中是可见的。 Moreover, all of the plurality of barbs 54a, 54b, 54c, etc. In this sectional view is visible. 虽然是两个通道46a 和46b和四个流体通道53a、 53b、 53c和53d被示出,但是通道的数目仅仅是示例性的,具有不同数目通道的该装置的实施方案均落入本发明的范围内。 Although two channels 46a and 46b and four fluid passages 53a, 53b, 53c and 53d are shown, but the number of channels is merely exemplary, and the number of channels having different embodiment of the device of the present invention fall within the range. 类似地,附在气囊51上的倒钩54a、 54b、 54c等的数目也可改变。 Similarly, the number of barbs 54a attached on the airbag 51, 54b, 54c, etc. may also vary.

图6示出了延伸出管状元件21的远末端23的抓紧器轴44,这更清晰地显示气囊51的形状。 FIG 6 shows a grasper extending shaft distal end 21 of the tubular member 23 44, which more clearly show the shape of the airbag 51. 气囊51通常是圆柱形的,其内表面附在抓紧器轴44的外部。 The air bag 51 is generally cylindrical, the inner surface of the outer shaft 44 attached to the grasper. 多个倒钩54a、 54b、 54c等附在气囊51的外部。 A plurality of external barbs 54a, 54b, 54c, etc. attached to the airbag 51. 如前面所述,当气囊51膨胀时,其外径便基本等于输卵管31的内腔30的直径,倒钩54a、 54b、 54c等便强行进入输卵管壁39中。 As described above, when the airbag 51 expands, it is substantially equal to an outer diameter of the fallopian tube lumen 31 diameter of 30 barbs 54a, 54b, 54c, etc. will be forced into the wall 39 in the fallopian tube. 每个倒钩都具有轴90,其在第一端91处附在气囊51的外部,且其在第二端92处具有尖端55,这样便很容易插进输卵管壁39的组织。 Each barb has a shaft 90 which, having a tip 55 and at a second end 92 attached to the outside of the first end 91 of the air bag 51, so that it is easily inserted into the oviduct tissue 39. 向后伸出的点56附在尖端55或其附近,且向轴90的第一端91方向延伸,这样它便可咬合组织以防止倒钩从输卵管壁39脱离。 Rearwardly projecting point 56 is attached at or near the tip 55, and extending in a direction 91 toward the first end of the shaft 90, so that it can snap off from the tissue to prevent the barbs 39 oviduct. 这些特征在倒钩54a 上明确地指出,但所有倒钩54a、 54b、 54c等都可包括这些特征。 These features are clearly indicated on the barb 54a, but all the barbs 54a, 54b, 54c, etc. can include these features. 气囊51和倒钩54a、 54b、 54c等以及抓紧器轴44组合在一起起到抓紧器38的作用。 The air bag 51 and barbs 54a, 54b, 54c, etc., and the grasper shaft 44 together function as grasper 38.

图6.5示出了本发明的又一个可供选择的实施方案,其中结扎带41是被袖套93推出管状元件21的远末端23,该袖套是管状袖套,其可滑移地绕置在管状元件21上,且可向远端滑动以将结扎带42推离管状元件21。 Figure 6.5 shows the present invention a further alternative embodiment, ligating band 41 in which the cuff 93 is introduced distal end of the tubular member 2321, which is a tubular sleeve cuff, which slidably around the home the tubular member 21, and slidably ligating band 42 to be pushed away from the tubular member 21 distally. 在此示出的这个实施方案和其它实施方案中,结扎带41 均是通过被推离管状元件21的远末端23而被释放。 This embodiment and other embodiments shown herein, ligating band 41 are the distal end 21 of the tubular 23 is released from being pushed through the element. 然而,本发明不局限于其中结扎带或其它结扎结构物是通过推动而被释放的实施方 However, where the present invention is not limited ligating band ligation or other structure is to be released by pushing embodiment

案。 case. 可以设计出其它的用于释放结扎结构物的装置,例如管状元件21 可在袖套93中收縮,这样,结扎带41保持在适当位置,而管状元件21从它下方收縮,因此结扎带可在被抓住的组织束上发生收縮。 Other means can be devised for releasing ligating structure, such as collapsible tubular member 21 in the sleeve 93 so that ligating band 41 is held in place, while the tubular member 21 from its contracted downward, thus ligating band may It shrinks the tissue bundles being caught. 此外, In addition,

用于在管状元件21的末端保持住结扎带或其它结扎结构物,且然后可将其释放至被抓住的组织束的其它装置可被设计出,并认为它们落在本发明的范围内。 Other means for holding the end of the tubular member 21 live ligating band ligation or other structure, and then releasing it to the tissue may be caught in the beam can be devised, and that they fall within the scope of the invention.

示于图6.5的本发明的实施方案也示出了抓紧器38的可替换形式, 其中如图3、 5和6示出的由抓紧器轴44和气囊51构成的伸长的导管被一个包含可膨胀的导管95的伸长的导管取代,该可膨胀的导管具有闭合端96和内部空腔97。 Shown in FIG 6.5 embodiment of the present invention also shows an alternative form of a grasper 38, wherein the 3, 5 and 6 is made as shown in FIG grasper shaft 44 and the elongated catheter balloon 51 is constituted comprising a expandable conduit 95 of the elongate catheter substituted, the expandable conduit having a closed end 96 and the interior cavity 97. 可膨胀的导管95是由柔软材料制成,其具有足够弹性,以至当内部空腔97的流体压力增加时,可膨胀导管95 在末端区域98膨胀或胀出。 The expandable conduit 95 is made of a soft material, having sufficient elasticity, even when the fluid pressure in the interior cavity 97 increases, the expandable conduit 95 is expanded in the end region 98 or bulge out. 当内部空腔97中的流体的压力减少时, 可膨胀导管95的末端区域98回到其原始直径。 When the pressure of the fluid in the internal cavity 97 is reduced, the expandable end region 98 of the catheter 95 is returned to its original diameter. 可膨胀导管95在功能上充分等价于如图3、 5和6所示的抓紧器轴44和气囊51的组合。 The expandable conduit 95 is functionally equivalent to the full grasper axis shown in FIG. 3, 5 and 6, a combination of 44 and 51 of the air bag.

图6.5还显示了钩状的线100,其为在图3、 5和6的实施方案中使用的倒钩的可替换的钩状结构。 Figure 6.5 also shows 100, which is used in the embodiment of FIG. 3, 5 and 6, the hook barbs line alternative hook structure. 在此剖面图中有两个可以看到,但可以使用多个钩子(如四个或五个)。 There are two can be seen, a plurality of hooks may be used (e.g., four or five) in this sectional view. 当可膨胀导管95未膨胀时,钩状线100与可膨胀导管95的外部相一致,这样,可膨胀导管95和钩状线100位于管状元件21内。 When the expandable conduit 95 is not expanded, the hook consistent with the external line 100 may be expandable conduit 95, so that the expandable conduit 95 and the hook-line 100 is located within the tubular member 21. 当可膨胀导管95膨胀后,钩状线100 向外张开,被推进输卵管(未显示)的内壁并将其抓住。 When the dilatation catheter 95 can be expanded, the hook outwardly flared line 100, is pushed into the inner wall of the fallopian tube (not shown) and grasp it. 当可膨胀导管95縮小时,钩状线100回到其原始位置。 When the dilatation catheter 95 can be reduced, the hook-line 100 back to its original position.

另一种可替换的抓紧器38示于图6.6中。 Another alternative grasper 38 shown in Figure 6.6. 可膨胀导管95如图7所示,如袖套93。 The expandable conduit 95 shown in FIG. 7, such as cuff 93. 示于图6.5中的钩状线100被吸管101取代,每一个吸管在其端部102或端部附近都有一个开口。 Shown in FIG. 6.5 by the straw hook wire 100 101 substituted, each has a straw opening 102 near its end or ends. 在图6.6中,开口103位于侧面,且端部102是闭合的。 In Figure 6.6, the opening 103 located on the side and the end portion 102 is closed. 当可膨胀导管95膨胀后,吸管101被向外推出,从而接触输卵管(未示出)的壁。 When the expandable conduit 95 may be expanded, pipette 101 is pushed outwardly so as to contact the fallopian tube (not shown) of the wall. 在控制部分24处与装置20相连并与吸管101连通的外部真空源使吸管101内形成真空,这样, 只要该真空被维持,吸管101便会牵拉输卵管的组织至开口103处, 将其夹在那里,从而起到了抓住输卵管的作用。 In the external control device 20 is connected to a vacuum source and communicating with the suction tube 101 at the portion 24 forming a vacuum inside the suction tube 101, so long as the vacuum is maintained, the suction pipe 101 will be pulled to the opening of the fallopian tube tissue 103, sandwiched there, which played a role in the fallopian tube to seize.

本发明的装置可用各种其它的抓紧器装置来构造。 Apparatus of the present invention may be various other grasper means configuration. 例如,类似于镊子的装置可被用来抓住输卵管内部的组织,或者其它的抓紧器装置也可被使用,例如图7和8所示。 For example, a device similar to forceps may be used to grasp the tissue inside the fallopian tubes, or other gripping means may also be used, for example, as shown in FIGS. 7 and 8. 在图7中,抓紧器38包括抓紧器轴57,它具有多个钩子58a、 58b、 58c和58d。 In FIG. 7, the grasper 38 includes a grasper shaft 57, having a plurality of hooks 58a, 58b, 58c and 58d. 在本发明的此实施方案中, 当一个或多个钩子58a、 58b、 58c和58d抓住输卵管的壁时,就实现 In this embodiment of the invention, when one or more hooks 58a, 58b, 58c and 58d when the catch wall of the fallopian tube, to achieve

了抓持。 The grip. 在示于图8的本发明的可供选择的实施方案中,抓紧器38包 In an alternative embodiment shown in FIG. 8 according to the present invention, the grasper 38 package

括抓紧器轴60和多个装在枢轴上的钩子61a和61b,其具有弯曲成角的末端62a和62b。 Including the grasper shaft 60 and a plurality of hooks mounted on a pivot shaft 61a and 61b, 62a having a curved end angled and 62b. 当抓紧器38处在管状元件21内腔45中收縮的位置时,装在枢轴上的钩子61a和61b将保持在闭合的位置(以虚线示出),但当抓紧器38伸出时,装在枢轴上的钩子61a和61b将移到它们张开的位置(图中以实线示出),然后再次闭合以抓住输卵管内部的组织。 When the grasper 38 in the lumen 45 of the tubular member 21 in the retracted position, the hook mounted on a pivot 61a and 61b will be held in a closed position when (shown in dashed lines), but extends grasper 38, a hook mounted on a pivot 61a and 61b will be moved to their open position (shown in solid line in the figure), and then closed again to grip the interior of the fallopian tube tissue. 装在枢轴上的钩子61a和61b在枢轴点63a和63b绕轴转动, 这是被位于抓紧器轴60内腔65中的促动装置64a和64b促动的。 Mounted on a pivot hooks 61a and 61b at the pivot points 63a and 63b is rotated about the shaft, which is located on the grasper shaft 60 lumen actuating means 64a and 64b of the actuator 65. 促动装置64a和64b可以是例如驱动杆,其穿过抓紧器轴60到达控制部分24,它们通过在那里的杠杆或触发装置来运动。 Actuating means 64a and 64b may be, for example, a drive rod, which passes through the grasper shaft 60 reaches the control section 24, they are moved by the lever or trigger device there.

图7和8也特别说明该装置的设计中的另一个变化。 7 and 8 also particularly illustrates another variation of the design of the device in FIG. 通过唇缘40 或以某些其它方式保持在管状元件21的远端的结扎带可以超过一个。 It can be more than one, or held by a lip 40 at the distal end of the tubular member 21 of ligating band in some other way. 在图7和8中,示出了两个结扎带41a和41b,但也可使用更大数目的结扎带。 In FIG. 7 and 8, illustrate two ligating band 41a and 41b, it is also possible to use a larger number of the ligating band. 如下所述,通过提供两个结扎带41a和41b,可能在输卵管中进行两次结扎,以便提供更为可靠的管阻断。 As described below, tubal ligation may be performed twice by providing two ligating band 41a and 41b, in order to provide a more reliable tube blocking. 为了按序释放结扎带41a 和41b,推进器气囊42 (图7中)或推进器盘48 (图8中)必须先伸出第一距离,该距离足够将结扎带41a推出唇缘40,然后伸出第二距离,该第二距离足够将结扎带41b推出唇缘40。 In order to sequentially release the ligating band 41a and 41b, the airbag pusher 42 (FIG. 7) or the pusher plate 48 (FIG. 8) must be extended a first distance, which distance is sufficient to launch the ligating band 41a lip 40, and projecting a second distance, the second distance sufficient to ligating band 41b Release lip 40. 为了按序推动两个结扎带,推进器气囊42将先膨胀至第一体积,然后膨胀至更大的第二体积。 In order to promote two ligating bands sequentially, the first propulsion balloon 42 is expanded to a first volume, and then expanded to a larger second volume. 类似地,推进器盘48将先后伸至两个不同的位置,该位置足够按序释放结扎带41a和41b。 Similarly, the pusher plate 48 extends to have two different position which is sufficient to release sequentially ligating band 41a and 41b. 用同一个装置,使用两个结扎带先后对两个输卵管进行结扎是可能的,但这不是优选的,因为该装置从一个输卵管撤回后,紧接着该装置又再插入到第二输卵管,这样就提供了污染该装置和引入污染物或感染物至子宫或第二个输卵管的机会。 Using the same means, using two successively ligating band ligation of both fallopian tubes is possible, but not preferred, because the withdrawal of the device from a fallopian tube, followed by the second device again inserted into the fallopian tube, so that providing the contamination of the apparatus and the introduction of contaminants or infectious agent to the uterus or fallopian tubes of a second chance.

可以注入抗生素、局部麻醉剂或其它药物至结扎区域。 It can be injected antibiotics, local anesthetics, or other drugs to the ligation region. 再参考图2, 药物可从管状元件21的端部23注入到输卵管31。 Referring again to FIG. 2, the drug may be injected from an end portion 23 of the tubular member 21 to the fallopian tube 31. 可提供一个或多个药物输送腔。 It may provide one or more drug delivery lumen. 例如,管状元件21的内腔45可以用作药物输送腔。 For example, the lumen of the tubular member 4521 may be used as a drug delivery lumen. 可选择地,可在管状元件21的壁内提供一个或多个药物输送腔,这可与图5中所示的通道46a和46b相比较。 Alternatively, one or more may be provided within the drug delivery lumen wall of the tubular member 21, the channel may be shown in FIG. 5, which is compared 46a and 46b. 作为进一步的可选择的实施方案,药物输送腔可通过增加第二管状元件而被提供,该第二管状元件围绕管状元件21,且与之共轴,因此在管状元件21和第二管状元件之 As a further alternative embodiment, the drug delivery lumen may be provided by increasing the second tubular member, the second tubular member around the tubular member 21, and coaxially therewith, and thus the tubular member 21 of the second tubular element

间形成药物输送腔。 Formed between the drug delivery lumen. 药物经由与药物输送腔相连的接通口37被注入到药物输送腔,如图l所示。 Drug via a switched port connected to the drug delivery lumen 37 is injected into the drug delivery lumen, as shown in Figure l.

如果需要,可以在抓紧器38内通入电流,以烧灼被抓住的组织。 If desired, current may be passed within the grasper 38, grasp the tissue to be cauterized. 例如,电流可以通过图2-6的装置的倒钩54a、 54b、 54c等,图6.5的装置的钩状线100,或通过示于图7和8的抓紧器的钩子58a、 58b、 58c、 58d或抓紧器61a、 61b等。 For example, current may barbs 54a by means of Figures 2-6, 54b, 54c, etc., of the hook-line apparatus 100 of FIG. 6.5, or by a grasper is shown in FIG. 7 and the hook 8 58a, 58b, 58c, 58d or grasper 61a, 61b and so on. 组织的烧灼具有减少流血的作用,而且烧掉少量组织可以促进输卵管从抓紧器38处释放。 Cauterizing bleeding tissue with reduced effect, a small amount of burned tissue and may facilitate the release of the fallopian tube 38 from the grasper. 组织的烧灼也可通过化学烧灼试剂的输送而实现,化学烧灼试剂的输送是通过上述药物输送腔完成的。 Cauterize tissue may also be achieved by transporting a chemical burning agent, a chemical burning agent delivery through said drug delivery lumen is completed.

应用了本发明的方法包括下面的步骤,这些步骤都是基于输卵管结扎做出的描述,但是这些步骤也可应用到其它管状解剖结构的结扎。 Application of the method of the present invention comprises the following steps, which are made based on the description tubal ligation, these steps may also be applied to other tubular anatomical structure ligation. 在讨论这些方法步骤的时候,特别参考了示于图l-3、 5和6的本发明的实施方案,但是这些步骤很容易推广到本发明的其它实施方案。 In discussing these method steps, with particular reference to the-3 l, embodiment 5 and embodiment 6 of the present invention shown in FIG, these steps can be easily extended to other embodiments of the present invention.

1) 装置的插入。 1) the insertion device. 第一步是将该装置插入到输卵管,如图1-3所示。 The first step is to insert the device into the fallopian tube, shown in Figure 1-3. 在该插入步骤中,为了避免对抓紧器38的组件的损坏和有利于装置的插入,抓紧器38在管状元件21中保持在未伸出的位置,装置通过相对平滑和易于插入的管状元件21远末端23的引导而插入到输卵管中。 In the insertion step in order to avoid damage to the grasper assembly 38 and facilitates insertion means, grasper 38 holding position is not extended in the tubular member 21, by means of a relatively smooth and easy insertion into the tubular member 21 the distal end of the guide 23 is inserted into the oviduct. 现在参考图l,实施该过程的人员通过控制部分24来控制装置20,将其远末端23插入到病人的阴道32,然后插入到子宫34的内腔33。 Referring now to FIG. Persons L, embodiment of the process is controlled by the control section 24 means 20, 23 to its distal end 32 is inserted into the patient's vagina, and then inserted into the uterine lumen 3334. 远末端23然后被引导到子宫角35和输卵管31的内腔30中。 Distal tip 23 is then directed into the uterus and fallopian tubes corner lumen 30 35 31. 在远末端23已经通过子宫角35并进入输卵管31后,远末端23的正确定位可通过监控管状元件22的长度来确定,如通过插入阻力的变化来确定。 After the distal tip 23 has passed through the uterine horn 35 and into the fallopian tube 31, distal tip 23 can be determined correctly positioned as determined by the length of the insertion resistance is varied by the monitor 22 of the tubular member. 管状元件22插入到子宫34和输卵管31也可由子宫镜引导实施。 The tubular member 22 is inserted into the uterus and fallopian tubes 34 a hysteroscope guide 31 may also be implemented. 装置20 可包括用于操纵远末端23的控制线(未示出),或在插入过程中利用其它使用了导管、在控制部分24上的操向控制器25的操纵办法来操纵远末端23。 Device 20 may include a control line for actuating the distal tip (not shown) 23, or with other catheter used in the insertion process, the operation control portion 24 approaches to the manipulation of the controller 25 to manipulate the distal end 23.

2) 抓紧器的伸出。 2) extending grasper. 如图6和9所示, 一旦管状元件21的远末端23被恰当地定位在输卵管31的内部,就将抓紧器38延伸出管状元件21。 6 and 9, once the distal end 23 of the tubular member 21 is properly positioned within the fallopian tube 31, the grasper 38 will extend out of the tubular member 21. 抓紧器38因此通过结扎带41的中心开口。 Therefore, by ligating the grasper 38 of the opening 41 with the center. 图9是该装置沿图6 中剖面线9-9的剖面视图。 9 is a sectional view of the device along section line 9-9 of FIG. 抓紧器轴44的伸出和缩回可由图1中控制部分24上的伸縮控制器26来控制,该控制器可以是例如引起机械连接运动的起动装置。 Grasper shaft extend and retract the telescopic control by the controller portion 24 to control 44 of FIG. 26, for example, the controller may cause movement of the mechanical connection of the starting device. 可以设计出用于引起抓紧器轴44以预定的距离延伸出管状元件21的各种装置,本发明的应用不局限于一种特定的装置。 Can design a specific means for causing the grasper shaft 44 to extend a predetermined distance from the tubular elements 21 of the various devices, application of the present invention is not limited.

3) 组织的抓住。 3) organization caught. 一旦抓紧器38延伸出管状元件21,抓紧器38 就被促动以抓住输卵管壁39内部的组织。 Once the graspers 38 extending tubular member 21, the grasper 38 can be actuated to grip the interior of the oviduct tissue 39. 示于图1中的控制部分24 可以包括用于控制抓持的抓持控制器27。 Shown in Figure 1 may include a control section 24 for controlling the gripping of the grip controller 27. 如图10所示,气囊51通过流过抓紧器轴44的流体而膨胀,直到气囊51的外径基本和输卵管31 的内径一样大。 , The airbag 51 is expanded by 10 the fluid flowing through the grasper shaft 44, until the OD of the balloon 51 is substantially as large as 31 and fallopian tubes. 倒钩54a、 54b等然后被推进输卵管,抓住或咬住输卵管壁39。 Barbs 54a, 54b, etc. then advanced fallopian tube, fallopian tube wall 39 to seize or bite. 自然地,组织的抓住也可通过别的可选择的抓紧器装置来实现,如那些示于图6.5, 6.6,图7和图8中的抓紧器装置。 Naturally, grasp the tissue may also be achieved through other alternative gripping means, such as those shown in FIG. 6.5, 6.6 grasper device, FIGS. 7 and 8.

4) 抓紧器轴和被抓住的组织的縮回。 4) shaft and a grasper caught tissue retraction. 如图ll所示, 一旦组织被倒钩54a、 54b等钩住,气囊51便收縮,朝着抓紧器轴44径向地向内牵拉输卵管壁39。 As shown in FIG ll, once the tissue barbs 54a, 54b, etc. hook, balloon 51 is shrunken, the grasper shaft 44 toward the radially inward pull tubal wall 39. 再参考图12,在气囊51縮小后,抓紧器38縮回到管状元件21的远末端23内。 Referring again to FIG 12, after the balloon 51 reduced, grasper 38 is retracted into the distal end 23 of the tubular member 21. 来自输卵管壁39的组织束70由抓紧器38牵引到管状元件21的远末端23内。 39 from the oviduct tissue bundles 70 is pulled by the grasper 38 to distal end 21 of the tubular member 23. 组织束70被牵引到管状元件21的远末端23内,在此同时,它被牵引通过结扎带41的中心开口。 Tissue bundles 70 is drawn into the distal end of the tubular member 21 and 23, at the same time, it is pulled with a central opening 41 through ligation.

5) 结扎带释放到组织束上。 5) ligating band is released into the tissue bundles. 如图13所示,通过推进器气囊42 的膨胀,结扎带41被推离唇缘40。 13, the pusher by the expansion of balloon 42, ligating band 41 is pushed away from the lip 40. 推进器气囊42可通过气体或流体, 如水或盐溶液而膨胀,这些气体或流体是通过通道46a和46b进入推进器气囊42的。 Pusher balloon 42 may be expanded by a gas or a fluid, such as water or saline, through which gas or fluid passages 46a and 46b into the airbag 42 of the pusher. 一旦被推离唇缘40,结扎带41就绕着组织束70发生收缩。 Once pushed away from the lip 40, 41 on ligating band 70 shrinks around the tissue bundles. 一种可供选择的释放装置,如示于图4或6.5的推进器装置,可用于该步骤。 An alternative release means, the pusher as shown in FIG. 4 or 6.5 can be used in this step. 推进器装置可通过推动控制器28控制,该推动控制器28 位于图1中的控制部分24。 Pusher means 28 may be controlled by pushing the controller, the pushing controller 28 located in the control section 124 in FIG.

如果组织束70包括来自管状解剖结构四周的组织,施用到组织束70上的结扎带41将实现输卵管31的阻断。 If the tissue comprises tissue derived from the beam 70 around the tubular anatomical structure, applied to the ligated tissue 70 with beam 41 blocked fallopian tubes 31 will be achieved. 另一方面,如果组织束70 仅包括来自输卵管31某一边的组织,组织束70的结扎仅仅是把该组织束70与输卵管31的余下部分分开,但是不阻塞输卵管31。 On the other hand, if the bundle 70 includes a tissue 31 from only one side of the fallopian tubes, tissue ligating beam 70 merely rest of the beam 70 of the tissue 31 with the fallopian tubes separately, but not tubal occlusion 31. 这在某些医学应用中是有用的,如结扎受损的或癌变的组织,当然,这对避孕是没有效果的。 This is useful for certain medical applications, such as damaged or cancerous tissue ligation, of course, this is no contraceptive effect. 一种能抓住管子周围各处组织的抓紧器将会得到包括来自该管子四周的组织的组织束70。 One kind can grasp around the tube surrounding tissue grasper comprises a tissue will be from the tissue surrounding the tube bundle 70. 通过抓住管子周围仅仅部分的组织,也是可能得到包括来自该管子四周的组织的组织束的,只要被抓住的组织的量足够大,以至于管子的劲度使得该管子的整个周围都 By grasping the tissue surrounding the tube only partially, it is also possible to obtain from an organization comprising a bundle of the tissue surrounding the tube, as long as the amount of tissue caught large enough that the stiffness of the tube such that the entire periphery of the tube are

被折叠而形成组织束。 Tissue is folded to form a bundle.

6) 被抓住的组织的释放。 6) release caught the organization. 在应用了一个或多个结扎带之后,组织 After application of one or more ligating band, tissue

束70必须从抓紧器38上释放。 Beam 70 must be released from the grasper 38. 这可通过简单地从组织束70上拉掉倒钩54a、 54b等来实现。 This may, 54b, etc. accomplished by simply pulling off the barbs 70 on the beams 54a from the tissue. 因为该结扎已经将组织束70与输卵管的主要部分分开,所以拉掉倒钩引起的组织损伤并无大碍。 Since the ligating tissue bundles 70 has separated from the main portion of the fallopian tube, the barbs pull out due to tissue damage does not matter. 可以将电流通过倒钩、钩子或抓紧器与组织相连的其它部分,或者输送化学烧灼剂, 从而烧灼组织,这可促进组织的释放并减少流血。 It may be part of the current through the other barbs, or hooks attached to the tissue grasper or transporting a chemical cauterizing agent, thereby cauterizing tissue, which can promote the release of tissue and reduce bleeding.

7) 装置的撤回。 7) withdrawal means. 在用结扎带41结扎组织束70,并从抓紧器38 上释放组织束70之后,该装置可被撤回。 After 41 with ligating band ligation tissue bundles 70, 38 and released from the tissue grasper beam 70, the device may be withdrawn. 图14示出了结扎的输卵管31,其中组织束70通过结扎带41绑住。 Figure 14 shows ligation of a fallopian tube 31, wherein the tissue through the tie beam 70 ligating band 41. 通过该结扎,输卵管31的内腔现在被分成两个部分:在靠近卵巢一边的远处内腔71;和在靠近子宫一边的近处内腔72。 By this ligation, tubal lumen 31 is now divided into two parts: near the far side of the lumen 71 ovarian; and near a lumen 72 near the side of the uterus. 如果期望的是仅仅单个结扎带被应用到输卵管上,该装置此时就可从输卵管中完全撤出。 If it is desirable that only a single ligating band is applied to the fallopian tube, this time the apparatus can be fully withdrawn from the fallopian tube.

8) 额外的结扎带的应用。 8) additional application ligation band. 现在参考图15,如果需要不止一个结扎带被应用到输卵管上,那么在第一个结扎带41a被应用到第一组织束70之后,管状元件21只是部分地撤回,而到达输卵管内一个新的、 更接近近端的位置,在该新的、更接近近端的位置,重复步骤2到5, 将第二结扎带41b施加到第二组织束70b上,从而产生双结扎。 Referring now to Figure 15, if desired more than one ligating band is applied to the fallopian tube, then the first ligating band 41a is applied to a first beam 70 after the tissue, the tubular member 21 is only partly withdrawn, the fallopian tube to reach a new , a position closer to the proximal end of the new, closer to the proximal position, repeat steps 2 through 5, the second ligating band 41b is applied to the second tissue beam 70b, thereby generating double ligation. 内腔72现在处在第一结扎和第二结扎之间,内腔73位于最接近近端的靠近子宫的一侧。 Now lumen 72 is between the first and second ligation ligation, uterine lumen 73 is located near the side closest to the proximal end. 步骤6到8可重复所需的次数以应用多个结扎带至输卵管;然而,能预料的是,通过一个到三个结扎带就可提供可靠的结扎, 而更多数目的结扎带不是必要的或期望的。 Step number 6 to 8 can be repeated to apply the required plurality of ligating band oviduct; however, can expect that can provide reliable ligation ligating band by one to three, and a larger number of ligating band is not necessary or desired.

为了实现绝育,结扎两个输卵管当然是必要的。 In order to achieve sterilization, tubal ligation two of course are necessary. 因此,该过程将以相似的方式重复用于第二个输卵管。 Thus, similar to the way the process will repeat for the second fallopian tube. 如上所述,由于存在感染的危险,将同一个装置从第一个输卵管中撤出,再插入到第二个输卵管的做法不是优选的。 As described above, since the danger of infection, to withdraw the same from the first device in the fallopian tube, and then inserted into the oviduct second approach is not preferred. 因此,优选的是,提供两个消毒的装置以实施两个输卵管的结扎。 Accordingly, it is preferable that the sterilization apparatus be provided in two embodiments ligation of both fallopian tubes. 制造具有一次性的部分或全部组件的装置在本发明的考虑范围内。 It means partially or all of the components in the manufacture of a disposable contemplated by the present invention.

在图16中标记为200的该装置的一个可供选择的实施方案部分地是由三个同轴导管202、 204和206形成的,这三个导管的直径按前面标注的数字顺序依次增加。 FIG. 16 labeled as the device 200 of an alternative embodiment of the partially formed by three coaxial conduits 202, 204 and 206, the diameter of these three conduits labeled in numerical order in order to increase the front. 该装置200被设计用于手术室里实施的应 The apparatus 200 is designed to be implemented in the operating room

用了局部麻醉的输卵管结扎过程。 Tubal ligation process with the local anesthesia. 装置200安装在子宫镜的操作通道 Apparatus 200 installed in the operating channel of the hysteroscope

(2.2mmlD)内,以便可以应用标准的子宫镜技术定位输卵管开口(输卵管口, ostium)和输送装置200至输卵管。 (2.2mmlD) inside, so that the standard may be applied positioning technique hysteroscope tubal opening (tubal ostium, ostium) and the conveyor means 200 to the fallopian tubes.

没有装配子宫镜的装置200的定位也可以被实现,从而为乡村或不发达国家的妇女提供了非手术的绝育选择。 Positioning apparatus not equipped with the hysteroscope 200 may also be implemented, thereby providing for the sterilization nonsurgical or rural women in developed countries. 使用弯曲成140°的套管, 手工引导该装置200的端部通过子宫角,将其粗略地定位在输卵管子宫部附近。 Use bent into the cannula 140 °, the guide hand end of the device 200 through the uterine horn, which is positioned roughly in the vicinity of the uterus oviduct portion. 然后将该装置200从套管推入输卵管口,并延伸约5厘米。 The apparatus 200 is then pushed into the tubal ostium from the sleeve, and extends about 5 cm. 插入发生阻碍时,就要求进行端部的操作,以找到位于套管端部的最小表面区域内的输卵管小口。 Insertion obstruction occurs, the operation requires an end portion, to find the small opening in the oviduct minimum surface area of ​​the sleeve end portion. 可通过20毫升盐水来验证输卵管的进入, 该盐水是通过导管204灌入的,此时盐水漏到套管或宫颈口则说明子宫(而非输卵管)的导管定位。 Can be verified by 20 ml of brine into the fallopian tube, the brine is poured via conduit 204, then brine leaking to the cervix then the cannula or catheter positioned uterine (fallopian tubes instead) is.

用于实施绝育的装置200中采用的导管202、 204和206优选是由压延尼龙,或其它合适的医学级聚合物制成。 Conduit 200 for use in sterilization apparatus embodiment 202, 204 and 206 are preferably made from extruded nylon, or other suitable medical grade polymer. 内部导管202是一个伸长的元件。 Internal conduit 202 is an elongated member. 导管202的远端208优选是柔软的,且形成有或带有可膨胀的气囊210。 The distal end 208 of the catheter 202 preferably is flexible, and has or carries an expandable balloon 210 is formed. 中间导管204的远端212具有可膨胀的端部,通常标记为214,它还带有0形圈216。 Intermediate conduit 212 has an end portion 204 of the expandable distal end, generally designated 214, with an O-ring 216 also. 外部导管206用于推动或部署该O形圈216到被套进内部的组织组织蒂(图15中的组织束70a和70b)上。 External conduit 206 for urging the O-ring or deployment quilt into the interior 216 to tissue connective tissue (tissue bundles 70a and 70b in FIG. 15). 操纵结构或辅助控制的结构没有被示出,但它们可以位于近端,或在每个导管202、 204和206上其它方便的位置,以有利于装置200及其组件的操纵。 Manipulation assist control structure or structures have not been shown, but they may be located proximally, or 202, 204, and 206 other convenient location of each conduit, and the actuating device 200 to facilitate assembly.

装置200的远端220有必要包括约1厘米长的双壳管道222。 The distal end 200 of the apparatus 220 is necessary to include about 1 cm long bivalve conduit 222. 管道222具有必要的柔韧性以减少在定位装置200的过程中输卵管穿孔的危险,同时在结扎过程中它用作可膨胀气囊210。 Conduit 222 with the necessary flexibility in the positioning process to reduce the risk of tubal perforation apparatus 200, while it is used in the ligation process expandable balloon 210. 管道222可由硅橡胶管道材料或其它可行的材料制成。 Conduit 222 may be made of silicone rubber or other piping materials possible.

在硅橡胶气囊210的双壳之间可以含有少量体积的氰基丙烯酸盐粘合剂或其它粘合剂,以起到辅助抓持的作用。 Between the silicone rubber bladder 210 may contain bivalve cyanoacrylate or other adhesive a small volume, in order to play a secondary role in gripping. 氰基丙烯酸盐粘合剂是基于其最小的粘度、长的保存寿命(在干燥环境中)和接触组织时的固化能力而选择的粘合剂。 Cyanoacrylate based adhesive is its minimum viscosity, long shelf life (in dry environment) and the curing ability of the contact selected tissue. 几种氰基丙烯酸盐粘合剂化合物被批准用于人体,但是TrufillTM (心脏神经血管的)目前被批准用于体内(非体表)应用。 Several cyanoacrylate compound is approved for human, but TrufillTM (cardiac nerves and blood vessels) is currently approved for in vivo (non-surface) application. 因为留下创伤的副作用对于此应用是被需要的,装置200 可不局限于使用Trufill粘合剂。 Because scarred side effects is needed for this application, the apparatus 200 may not be limited to the use Trufill adhesive.

气囊210的内壳可以是无孔的,而外壳处在松弛的状态,具有足够小的孔,以防止粘合剂过早地通过。 Balloon shell 210 may be non-porous, and the housing is in the relaxed state, it has a sufficiently small aperture to prevent the adhesive from prematurely pass. 装置200可提供注射器225以膨胀气囊210。 Apparatus 200 may provide a syringe to inflate the balloon 225 210. 其它的膨胀装置也是可行的。 Other expansion means are also possible. 气囊210的膨胀拉扯幵外壳上的孔,便允许局部的粘合剂通过在外气囊中的这些孔输送出去, 以便气囊210粘合到将要被阻断的输卵管的内壁部分。 Inflation of the airbag 210 in the housing hole pull Jian, allow partial adhesive transfer out through the holes in the outer bag, so that the airbag 210 is bonded to the inner wall portion to be blocked fallopian tube. 外壳中的孔被布置以使气囊210上产生间隔开的轴向排列的粘合剂条带,这方便了膨胀的和粘住了的气囊210回縮。 Holes are arranged in the housing such that the airbag 210 generates strips of adhesive spaced apart axially aligned on, which facilitates the expansion of the airbag 210 and the stick retraction.

图17-20说明了该装置在结扎过程中的操作。 17-20 illustrate the operation of the device in the ligation process. 在图17中,为了在输卵管230中产生阻塞,装置200的远端220被插入到所需的位置。 In FIG 17, in order to generate blocking the fallopian tube 230, the distal end 200 of the apparatus 220 is inserted to the desired location. 女性避孕结扎的最佳括约肌位置在靠近壶腹峡部(ampullaiy-isthmic) 联结处(距输卵管口4-5厘米)的远端的位置,此处输卵管的内径从2 毫米急剧增大到5毫米。 Best female contraception ligation sphincter position location (4-5 cm from the tubal ostium) in the distal end (ampullaiy-isthmic) coupled near the isthmus ampulla, fallopian tubes where the inner diameter sharply increases from 2 mm to 5 mm. 在壶腹状管中壁厚与内径的比率使该它成为适合于内陷的首选区域。 In ampullar tube wall thickness to inside diameter ratio so that it becomes suitable for the preferred retraction region. 在定位于壶腹状管中后,导管204的端部214 膨胀到5毫米,近似等于输卵管的内径。 After positioned ampullar tube, the end portion 214 of the conduit 204 is expanded to 5 mm, is approximately equal to the inner diameter of the fallopian tube. 装置200然后(向近处)撤回,直到对膨胀的端部214的阻力阻止进一步的撤回。 Apparatus 200 is then withdrawn (proximally) until the resistance to expansion of the end portion 214 to prevent further withdrawal. 该过程确保了在壶腹峡部联结处中适当的定位。 This process ensures that the proper positioning of the coupling at the isthmus of the ampulla. 图18绘出了气囊210的膨胀,将粘合剂施于气囊210和管子230内表面232之间的接触处。 Figure 18 depicts the inflation of the airbag 210, the airbag 210 and the adhesive applied to the inner surface of the tube 230 between the contacts 232. 气囊210可用福尔马林溶液,如10%的福尔马林来充胀。 Balloon 210 may formalin solution, such as 10% formalin for inflation. 此外,示于图17和18 中的可膨胀的端部214具有多条腿235,每条腿235都处在基本塌陷或缩回的位置,以便插入到管子中。 Further, shown in FIGS. 17 and 18 of the expandable end portion 214 having a plurality of legs 235, each leg 235 are in a substantially collapsed or retracted position, for insertion into the tube.

图19说明了气囊210相对于折叠机构237向近处縮回,该机构237 部分地由膨胀的端部214的结构构成。 19 illustrates the airbag 210 with respect to the folding mechanism 237 is retracted proximally, the mechanism part 237 is constituted by an end portion 214 of the expansion. 折叠机构237增加了靠近于被抓住部分的近端的管子230的直径,这有助于翻转管子230。 The folding mechanism 237 increases close to the proximal end of the catch portion 230 of the tube diameter, the tube 230 which helps to flip. 在图示的装置200中,气囊210向近端的縮回同时促动了折叠机构237。 In the illustrated apparatus 200, the airbag 210 is folded while the actuator mechanism 237 to the retracted proximally. 如图20所示,气囊210如期望地縮小以辅助形成紧凑的组织蒂250,尽管这不是必须的。 As illustrated, the balloon 210 as desired to assist in reduction 20 form a compact tissue pedicle 250, although this is not essential. 图20还显示了导管206向远端移动以部署0形圈216, 该0形圈从而作为围绕着组织束250的遗赠带(legator band)。 FIG 20 shows the catheter 206 also moves distally to deploy the O-ring 216, the O-ring so that as the tissue around the legacy zone 250 of the beam (legator band). 在某些情形下,导管206的远端还可用作被动的折叠辅助装置,或者用来压紧组织蒂250。 In certain instances, the distal end of catheter 206 may also serve as a passive folding auxiliary means, or to compress tissue pedicle 250.

在部署了O形圈后,管子230立即被密封一小段时间,至少直到组织蒂250坏死且其组织脱落。 After deployment of the O-rings, tubing 230 is sealed immediately a short time, at least until the tissue pedicle 250 and necrotic tissue loss thereof. 牵拉处于附着状态的气囊210,促使形 Pulling the airbag 210 in an attached state, prompting shaped

成局部创伤,以提供管子230更长时间的阻塞。 Topical wound, to provide a longer occlusion in the tube 230. 此时,希望的是让气囊210保持附着,这是为了福尔马林从气囊210泄漏以促进靠近O形圈近端的管子内部形成创伤,从而提供长期的避孕。 In this case, it is desirable is to remain attached to the airbag 210, which is to formalin leakage from the balloon inside the tube 210 near the proximal end to facilitate the formation of an O-ring wound, thereby providing long-term contraception. 永久性的管子阻塞是通过在结扎括约肌处形成创伤组织而维持的。 Permanent tube is blocked by the formation of wound tissue ligation sphincter and maintained. 长时间暴露于弹性结扎带216引起持久的炎症反应,导致更稳定的创伤组织形成。 Prolonged exposure to an elastic ligating band 216 caused by persistent inflammation, wound tissue resulting in a more stable form. 而且, 靠近该输卵管括约肌注入10%的福尔马林溶液防止了上皮细胞再生, 并辅助永久性创伤的形成。 Further, adjacent to the sphincter oviduct injection of 10% formalin solution prevents regeneration of epithelial cells, and aid in the formation of a permanent wound. 在本发明的考虑范围内,可替换地或者额外地,提供电源烧灼组织蒂的组织,有效地辅助导管202与气囊210 的分离。 In the contemplated scope of the invention, alternatively or additionally, to provide power cauterize the tissue pedicle tissue, effectively assist the separation conduit 202 and the balloon 210. 可选择地,在导管202中,在给定的张力下,导管202优选可以某种方式连到气囊210上,以在已知的弱连接处分开。 Alternatively, the conduit 202, at a given tension, preferably conduit 202 may be connected in some way to the air bag 210 to open the weak link in a known disposition.

图示的折叠机构237包括多个腿235,它们绕着中央线间隔开,每个腿235在大腿241和小腿243之间具有膝状物239。 Illustrated folding mechanism 237 comprises a plurality of legs 235 which are spaced apart about the center line, each leg having a knee was 235 239 241 and the leg 243 between the thigh. 腿235被期望具有这样的尺寸,即大腿241的轴向长度等于或大于相应小腿243的长度。 Leg 235 is expected to have such a size, i.e., the axial length of the thigh 241 is equal or greater than the length of the respective legs 243. 这样在气囊210向近端收缩时,这样的相对长度有助于在管子230 的壁内形成四周都有的折叠。 So that when the balloon 210 proximally retracted, such relative longitudinal folding contributes all around the tube 230 is formed in the wall. 大腿241比小腿243长引起管子230的壁产生巻绕,因此随着小腿243朝大腿241旋转移动,管子230的管状部分的近端和远端发生翻转。 Longer than leg 243 leg 241 causes the tube wall 230 produced about Volume, so as the rotation of the leg 243 moves toward leg 241, a proximal end and a distal end 230 of the tubular portion of the tube overturns. 长的大腿241也由此形成斜坡,或称为表面导引,这有助于0形圈216的部署。 Long legs 241 are thus formed into a slope surface of the guide, or referred to, which helps to deploy the O-ring 216. 具有单个活动组件如单条腿235的折叠机构237也在考虑的范围内,尽管这在目前不是优选的。 Having a single active component in the range of the folding mechanism 237, such as a single leg 235 are also contemplated, although this is not currently preferred.

这里说明的活动折叠机构237可以考虑形成一个或多个四节连接(four-bar linkage),它包括导管202的结构、可膨胀的端部214和导管204。 Activities folding mechanism 237 described herein can be considered to form one or more sections connected to four (four-bar linkage), which comprises a structure of the catheter 202, the expandable end 214 and the conduit 204. 可膨胀的端部214的远端部分可旋转地附在导管202的远端。 The expandable distal end portion 214 is rotatably attached to the distal end 202 of the catheter. 在保持导管204固定的同时,导管202向近端的移动导致膝状物239 弯曲并向外径向偏斜,由此膨胀了端部214,并增加了管子230的该局部部分的半径。 While holding the catheter stationary 204, 202 causes movement of the proximal end of the catheter to bend the knee was 239 and deflect radially outwardly, thereby expanding the end portion 214 of the tube 230 and increases the radius of the local portion. 在使用中,抓持结构如气囊210保持(或甚至减小) 管子230的第一管状部分245的直径。 In use, the gripping structure, such as balloon 210 remains (or even reducing) the diameter of the first tubular portion 230 of the tube 245. 通过膝状物239的横向运动, 管子230近端的第二管状部分249的直径增加。 By lateral movement of the knee was 239, increasing the diameter of the proximal end of the second tubular portion 230 of the tube 249. 如图20所示,第二部分249折叠于第一部分上(翻转管子),由此产生组织束或组织蒂250。 20, a second portion 249 folded over the first portion (inverted tube), thereby producing tissue or tissue pedicle beam 250.

活动装置通常能被定义成设置为可活动的连接的结构,它将一种形式的作业或在一个方向上的位移转换为另一种形式的作业或不同方向上的位移。 Active devices are typically connected to the structure can be defined to be active, it will be a form of work or converts a displacement in a displacement direction or different directions on the work of another form. 在被说明的折叠机构237的情形中,导管202向近端的 In the case of the illustrated folding mechanism 237, the catheter 202 proximally

(轴向的)位移被有效地转换为膝状物239的径向位移。 (Axial) displacement of the knee is efficiently converted to radial displacement was 239. 于是,膝状物239扩展管子230的横截面至有效的直径,该直径大于被气囊210 抓住的直径。 Thus, the knee was 239 cross section of the pipe 230 extended to the effective diameter, which is larger than the diameter of the balloon 210 caught. 可以将这样的活动机构237与被动的折叠辅助装置如导管206远末端的基本固定的几何形状相比较。 237 may be compared to such activity means and passive means, such as folding auxiliary substantially fixed geometry of the catheter distal tip 206. 导管206远处的开口端可辅助折叠管子230,或压紧部分折叠的组织蒂250,但是,导管206 本身的径向位移并没有发生主动的减少。 Open end of the conduit 206 remote tube 230 may assist folded, partially folded or pressed tissue pedicle 250, however, the radial displacement of the conduit 206 itself does not occur and active reduced. 事实上,可以要求导管206 的远端发生扩展以容纳组织蒂250的插入。 In fact, the distal end of conduit 206 may be required to accommodate the expansion occurring tissue pedicle 250 is inserted. 在这样的情形中,大腿241 可用作楔子以压縮组织蒂250的直径。 In such a case, thigh 241 may be used to compress the diameter of the wedge 250 of tissue pedicle.

虽然子宫输卵管造影术可用于证实完成的管状阻塞,但这些方法是昂贵的,通常在发展中国家是行不通的。 Although hysterosalpingography may be used to confirm the completion of the tubular blocking, but these methods are expensive and usually not feasible in developing countries. 一种用于可视化的廉价的替代方案开发了这样一个事实,即输卵管远末端对腹膜空腔是天生开放的。 Inexpensive alternative for visual development of the fact that the peritoneal cavity of the fallopian tube distal tip opening is born. 在子宫注入亚甲基蓝之后,染料扩散到腹腔中,然后在不到30 分钟的时间内便被肾脏处理和排泄。 After the methylene blue uterine implantation, diffusion of the dye into the abdominal cavity, and then in less than 30 minutes will be processed by the kidneys and excreted. 只有完全阻塞的管子能防止染料在这样的时间里被扩散和排泄。 Only complete blockage of the tube can be prevented from being diffused dye and excretion in such time.

虽然本发明是按照特定的具体实施方式描述和说明的,但本领域的技术人员将明白并理解这不是限制。 Although the present invention has been described and illustrated in a particular specific embodiments, those skilled in the art will understand and appreciate that this is not limiting. 而且,对这些特定实施方式所作的修改和删除能够被完成,而不偏离由权利要求限定的本发明的范围。 Furthermore, for these specific embodiments can be made by modification and deletion is completed, without departing from the scope of the invention defined by the claims. 而且, 一个具体实施方案中的特征和元素同样可应用到另一个实施方案,而不偏离由权利要求限定的本发明的范围。 Further, a specific embodiment of the features and elements are equally applicable to the other embodiments without departing from the scope of the invention defined by the claims.

Claims (15)

1.一种装置,其用于翻转管状解剖结构的第一管状部分,以形成组织束,并施加至少一个结扎结构物至所述组织束,其包括:伸长的管道,其包括远末端、近末端和其间的内腔,其中所述远末端适应于插入所述管状解剖结构;装在伸长元件的远末端的抓紧器,所述伸长元件被可滑移地安置在所述内腔中,所述抓紧器能够从所述管道向远处伸出,抓住所述管状解剖结构内部上的组织,带着所述被抓住的组织向近处缩回;活动的折叠机构,其经配置和安排以辅助所述抓紧器翻转所述第一管状部分;结扎结构物,其可被释放地携带在所述装置的远末端附近;以及施加结构,其被安置在所述管道的所述远末端的附近,该施加结构适应于施加所述结扎结构物至所述组织束。 1. An apparatus for inverting a first tubular portion of the tubular anatomical structure, to form a tissue bundle, and applying at least one ligating the tissue structure to the bundle, comprising: an elongated conduit comprising a distal tip, proximal end and a lumen therebetween, wherein the distal tip is adapted to be inserted into the tubular anatomical structure; distal tip mounted grasper elongate element, said elongate element being slidably disposed in the lumen , the grasper can extend distally from the duct, grasp the tissue inside of the tubular anatomical structure, with the caught tissue retracted proximally; folding mechanism of activity, which configured and arranged to assist the grasper inverting said first tubular portion; ligation structure, which may be releasably carried in the vicinity of the distal end of the device; and applying a structure, which is disposed in the conduit by near said distal end, the applicator is adapted to apply the structure ligating the tissue structure to the beam.
2. 如权利要求1所述的装置,其中所述抓紧器包含位于所述折叠机构远端的气囊结构,其可支配地发生膨胀。 2. The apparatus according to claim 1, wherein the grasper comprises a balloon structure at the distal folding mechanism, the expansion which occurs may be disposable.
3. 如权利要求2所述的装置,其中所述抓紧器进一步包含粘合物质,其通过所述气囊的膨胀而被释放,从而在所述气囊和所述被抓住的组织之间形成粘合层。 3. The apparatus according to claim 2, wherein the grasper comprises a further adhesive substance, which is released by the expansion of the airbag, thereby forming a stuck between the balloon and the tissue being caught seal layer.
4. 如权利要求3所述的装置,其中所述气囊包括双层壁的膨胀结构,该结构具有外壁和内壁,在所述外壁和内壁之间放置有粘合物质, 所述膨胀结构的外壁具有孔,当所述气囊膨胀时,所述孔可扩展以允许所述粘合物质通过所述扩展了的孔。 4. The apparatus according to claim 3, wherein the expandable balloon comprises a double-walled structure, the structure having outer and inner walls, with an adhesive material disposed between the outer wall and an inner wall, an outer wall of the expandable structure has a hole, when the airbag is inflated, the holes may be extended to allow the adhesive material extends through said bore.
5. 如权利要求1所述的装置,其中所述折叠机构包括: 具有膝状物的腿,该膝状物可适应径向移动,从而扩展所述管状解剖结构第一横截面至其直径比在被所述抓紧器抓住的位置处的所述管状解剖结构第二横截面的直径大,以便当所述抓紧器相对于所述折叠机构向近端縮回时,辅助在所述管状解剖结构内形成环绕四周的折叠。 5. The apparatus according to claim 1, wherein said folding mechanism comprising: a knee-like leg, the knee was adapted to be moved radially, thereby expanding the tubular anatomical structure to a first cross-sectional diameter than so that when the gripping means is folded relative to the proximally retracted, the auxiliary tubular anatomical the large diameter of the tubular anatomical structure of the second cross-section at the position of the grasper caught, forming a folded structure surrounded within.
6. 如权利要求5所述的装置,其中所述腿包括在所述膝状物的远端的小腿部分;和在所述膝状物的近端的大腿部分。 6. The apparatus as claimed in claim 5, wherein said leg includes a distal end portion of the lower leg knee substance; in the thigh and knee portion of the proximal end of the substance.
7. 如权利要求6所述的装置,其中所述小腿部分和所述大腿部分具有近似相等的长度。 7. The apparatus according to claim 6, wherein said thigh section and said calves section having approximately equal length.
8. 如权利要求6所述的装置,其中所述小腿部分的长度比大腿部分的长度小,由此当所述抓紧器从抓紧咬住的位置向近端移动至折叠位置时,导致所述膝状物的第一、向外的、径向移动,和所述膝状物的第二、向内的、径向移动。 8. The apparatus according to claim 6, wherein the length of the lower leg portion is smaller than the length of the thigh portion, whereby when the grasper is moved from a position gripping the proximal end to bite the folded position, resulting in the the first knee-like, outward radial movement of the knee and a second substance, inward, radial movement.
9. 如权利要求5所述的装置,包括多个有轴节的腿,每个腿都有膝状物,所述腿的设置使多个膝状物绕中央线间隔开,且使所述多个膝状物一致地共同动作,从而扩展所述第一横截面。 9. The apparatus according to claim 5, comprising a plurality of legs with a shaft section, each leg has a knee-like, the leg was disposed a plurality of spaced apart around the knee center line, and the a plurality of knee joint was consistent operation, the first cross-section to extend.
10. 如权利要求1所述的装置,其中所述施加结构包括所述管道的所述远末端的一部分。 10. The apparatus according to claim 1, wherein said structure comprises applying a portion of the distal end of the conduit.
11. 如权利要求1所述的装置,其中所述结扎结构物包括弹性O 11. The apparatus according to claim 1, wherein said structure comprises an elastic ligating O
12. —种用于在管子内部两端间的中间位置阻断柔性管子通道的装置,包含:管道,其包括远末端、近末端和其间的内腔,所述远末端适应于插入到所述管子的一个开口端;气囊,其包括双层壁的膨胀结构,该结构具有外壁和内壁,在所述外壁和内壁之间放置有粘合物质,所述膨胀结构的所述外壁具有孔, 当所述气囊膨胀时,所述孔可扩展以允许所述粘合物质通过扩展了的所述孔;伸长元件,其具有的远末端适应于携带所述气囊,所述伸长元件可滑移地被安置在所述内腔中,所述气囊能够从所述管道向远端伸出, 发生膨胀从而依靠粘性抓住所述管子内部的第一管子部分,并与所述第一管子部分向近端缩回;结扎结构物,其可被释放地携带在所述装置的远末端附近;以及施加结构,其被安置在所述管道的所述远末端的附近,该施加结构适应于施加所 12. - a kind of an intermediate position between both ends of the blocking means inside the tube passage of flexible tubing, comprising: a conduit comprising a distal end, a proximal end and a lumen therebetween, said distal end adapted to be inserted into the one open end of the tube; balloon double wall structure which includes an expansion, the structure having an inner wall and an outer wall, the outer and inner walls are placed between the adhesive substance, the expansion of the outer wall structure has a hole, when when the balloon is inflated, the holes may be extended to allow the adhesive material extends through the aperture; elongated member having a distal end adapted for carrying the balloon, the elongate member slidably being disposed in the lumen, the balloon can extend distally from the pipe, expands so as to depend viscous part of the interior of the first tube to seize the tube and the first tube portion to retracted proximally; ligation structure, which may be releasably carried in the vicinity of the distal end of the device; and applying a structure, which is disposed in the vicinity of the distal end of the conduit, which is applied to the structure adapted to be applied 结扎结构物,从而阻断所述通道。 Ligation structure, thereby blocking the channel.
13. 如权利要求12所述的装置,进一步包括:折叠辅助结构,其定位、设置和安排可以辅助所述气囊翻转所述管子的一部分。 13. The apparatus of claim 12, further comprising: an auxiliary folding structures positioned, disposed and a portion of the airbag arrangement can assist inverting the tube.
14. 如权利要求13所述的装置,其中所述折叠辅助结构包括一种机构,其可被操作以增加位于所述第一管子部分的近端的第二管子部分的直径,由此允许所述第一管子部分向近端收縮至所述第二管子部分内的同轴位置,从而在所述管子内产生环绕四周的折叠,并形成组织蒂。 14. The apparatus according to claim 13, wherein said folding auxiliary structure comprises a mechanism which can be operated to increase the diameter of the proximal end portion of the second tube in the first portion of the tube, thereby allowing the said first tube portion to the proximally retracted position within the coaxial second tube portion, resulting in a folded and surrounded by said tube, and forming a tissue pedicle.
15. 如权利要求14所述的装置,其中所述机构包括:多个腿,每个腿都具有膝状物,所述腿的设置使多个膝状物绕中央线间隔开,且可使所述多个膝状物协同地径向移动以增加所述第二管子部分的直径。 15. The apparatus according to claim 14, wherein said mechanism comprises: a plurality of legs, each of the legs having knee-like, the leg was disposed a plurality of spaced apart around the knee center line, and can the plurality of radial movement of the knee was synergistically to increase the diameter of the second tube portion.
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US20030158563A1 (en) 2003-08-21 application
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